[Choice of an alternative access in failed endovascular intervention through the right radial artery]. / Vybor al'ternativnogo dostupa pri neudache éndovaskuliarnogo vmeshatel'stva cherez pravuiu radial'nuiu arteriiu.

The transradial access has deservedly become the 'gold standard' while performing various X-ray endovascular interventions both diagnostic and therapeutic ones. However, along with all its advantages, it is not without disadvantages. These difficulties for the most part are related to peculiarities of the anatomy of upper-limb arteries. It is exactly complex anatomy that is the most common cause of complications and compelled change of the access while using the right radial artery. The purpose of our study was to examine the symmetry of complex anatomy of upper-limb arteries in order to choose an optimal and safe way of conversion of the access in case of forced refusal from the right radial access. For this reason there was developed an open multicentre registry acronymized as COMPAAS (COMPlex Anatomy of Arteries and Symmetry). During the work of this Registry from February to December 2018, correspondents of the study became 35 colleagues from 23 clinics of 11 cities of Russia. The working group analysed a total of 127 patients presenting with 157 variants of complex anatomy of lower limb arteries: high bifurcation of the radial artery (84), complete loop or tortuosity (66), and compartmental calcification of brachial arteries (7). The anatomy of arteries on the opposite upper extremity was studied based on angiographic findings. The most frequent variant (84 cases) of complex anatomy was high bifurcation of the radial artery at the level of the a. brachialis (20.9% of cases), with the origin of the brachial artery at the level of the a. axillaris being revealed half as often (9.9%). The maximum percentage of symmetry was observed in the group of patients presenting with compartmental calcification of upper-limb arteries (85.7%). Complete loop or marked (more than 100°) tortuosity of arteries on both arms was revealed in 54% of cases. Besides, in 25% of cases, tortuosity was combined with the high origin of the radial artery. It is noteworthy that none of the 127 patients appeared to have complex anatomy on the a. ulnaris. When revealing pronounced calcification of arteries of the forearm or a combination of high bifurcation with tortuosity, it seems feasible to decide upon conversion of the access to the femoral one (a. femoralis) or ulnar (a. ulnaris). In isolated high bifurcation on the right, effective conversion to the contralateral (left) radial approach is possible in not less than 75% of cases.

[Long-term clinical efficiency of endovascular treatment using Cypher rapamycin-eluting stents in patients with coronary heart disease].

The study was undertaken to analyze the long-term results in patients with coronary heart disease (CHD) one year or more after Cypher stent implantation. It covered 1221 patients. One-, two-, and three- vessel lesions were observed in 693 (56.8%), 344 (28.2%), and 184 (15%) patients, respectively. A total of 1967 Cypher stents were implanted. The results of treatment were analyzed 1 and 2 years after intervention. The efficiency of a procedure was evaluated by the following parameters: the presence or absence of anginal symptoms, the presence and absence of complications (fatal outcome, myocardial infarction). The following morphological parameters: the rate of restenosis and that of late stent thrombosis were also assessed. The results of one- and two-year follow-ups were used to make a multivariate analysis of the clinical and morphological predictors of coronary complications (fatal outcome, myocardial infarction, recurrent angina pectoris) in the late period, as well as the predictors of restenosis and late stent thrombosis. Restenosis following 1 year of Cypher stent implantation is 3.1%. The factors that significantly increase the risk of this complication within the first year are diabetes mellitus and revascularization in the patients operated on. The one-year rate of Cypher stent thromboses is 1.6%. Patients' discontinuation of antiaggregant therapy is the sole factor that significantly increases the rate of their late thromboses in this period. Within the second year of a follow-up, the rate of late Cypher stent thromboses is 1.8%. The risk of this complication is significantly increased by factors, such as a lengthy (more than 3 mm) stented portion, renal failure, and less than 40% left ventricular ejection fraction.

[Comparative analysis of the X-ray morphology of coronary atherosclerosis and the results of endovascular interventions performed in the subacute period and 6 months after prior myocardial infarction].

The study was undertaken to analyze the morphology of coronary lesion and the angiographic results of interventions made in the subacute period and 6 months after prior myocardial infarction. It included 593 patients with and without prior Q-wave myocardial infarction. The X-ray morphological parameters of the coronary bed were analyzed in the patients who had undergone invasive studies within a month (n = 362) and 6 months (n = 231) after sustained myocardial infarction. In both groups, the successful intervention rate was also estimated during endovascular treatment. The study showed that the number of stenoses with the complicated morphology (type B) was significantly more 6 months after sustained myocardial infarction than that in the subacute period. The number of occluded segments with the characteristics that were unfavorable for endovascular intervention (bridge collaterals, extended occlusions) was also significantly more in the late periods. In the subacute period, the angiographic success rate of endovascular recanalizations of chronic occlusions was 83.4%, which was significantly higher than that (62.6%) 6 months following infarction. The findings have led us to the conclusion that it is necessary to make routine coronary angiography in all postinfarction patients during their hospital stay in order to define the potentialities of early revascularization.

[High-frequency jet ventilation of the lungs during intensive care of cardiogenic shock and pulmonary edema in patients with myocardial infarction]. / Vysokochastotnaia struinaia ventiliatsiia legkikh pri intensivnoi terapii kardiogennogo shoka i oteka legkikh u bol'nykh infarktom miokarda.

High-frequency (HF) jet ventilation through transtracheal catheter has been used for the therapy of acute respiratory failure in 30 patients ith myocardial infarction complicated by pulmonary edema and cardiogenic shock. Gas exchange and central hemodynamics have been assessed, using a Swan-Ganz catheter fixed in the pulmonary artery. HF ventilation led to a decrease of hypoxemia, pulmonary blood shunting and to a moderate increase in the cardiac output.

[Effectiveness of the use of high-energy lasers in bronchology]. / Effektivnost' primeneniia vysokoénergeticheskikh lazerov v bronkhologii.

Bronchoscopy by laser radiation was performed in 141 patients. CO2 laser was used in 89 patients: 25 had pulmonary tuberculosis, 6 tumours, 35 stump inflammation, and 23 other diseases. YAG laser was used in 52 patients: 15 of them had tumours, 21 bronchial tuberculosis, 6 osteochondropathy and 10 other diseases. A good therapeutic result was obtained in most patients but in certain cases (malignant tumours) it was palliative. Special features and technical difficulties encountered during work with different types of lasers in fibroscopy under anesthesia and in fibrobronchoscopy under local narcosis are discussed. No complications were registered. Formation of the so-called "white thrombus" at the site of laser photodestruction was described which required removal during control bronchoscopy.

[Possibilities of instrumental biopsy methods in the diagnosis of rarely occurring disseminated processes of the lungs]. / Vozmozhnosti instrumental'nykh biopsiinykh metodov v diagnostike redko vstrechaiushchikhsia legochnykh disseminatsii.

Fifty eight patients with disseminated lung lesions were investigated, including 19 with histiocytosis X, 5 with alveolar microlithiasis, 8 with pulmonary phospholipoproteinosis, 16 with idiopathic hemosiderosis, 1 with primary pulmonary amyloidosis and 9 with primary diffusive tumors of the lungs. In all the above cases, a complex bronchological examination was undertaken with the use of different biopsy transbronchial procedures as well as an open biopsy of a lung. Diagnostic value and efficiency of bronchobiopsies were considered. Recommendations concerning the use of different instrumental techniques were formulated.

[The instrumental diagnosis of disseminated lesions of the lungs]. / Instrumental'naia diagnostika disseminirovannykh porazhenii legkikh.

A study is presented of 52 patients with disseminated pulmonary lesions. Among them: histiocytosis X--17, alveolar microlithiasis--5, pulmonary phospholipoproteinosis--7, idiopathic hemosiderosis--14, primary pulmonary amyloidosis--1, primary diffuse lung tumours--8. All patients were subjected to complex bronchological examination including use of different biopsy transbronchial methods as well as open biopsy of the lung. The diagnostic value of the employed bronchial biopsies is discussed. A diagnostic algorithm of rarely met pulmonary disseminations has been developed. Recommendations on the use of different instrumental methods are formulated.

[Use of carbon dioxide laser in the treatment of tuberculosis of the bronchi and trachea in children and adolescents]. / Primenenie uglekislotnogo lazera v lechenii tuberkuleza bronkhov i trakhei u detei i podrostkov.

The first experience with using carbon laser in treatment of specific bronchial affections in children and adolescents was studied. Persisting lymphobronchial fistulas and granulations in 4 children and adolescents were considered as indications to the treatment. The 2-3 exposures, to laser during bronchoscopy with burning out the granulations and caseous led to rapid healing of the fistulas and epithelization of the bronchial surface with formation of small cicatrices. No complications were observed.